Compassion and its role in the clinical encounter – An argument for compassion training

Empathic communication, (i.e. emotionally engaging with a patient), is an important part of the therapeutic relationship. It has been shown to improve the health and therapeutic outcomes for patients by improving diagnosis and compliance. In the West, front-line medical professionals, including herbal medicine practitioners, put themselves at risk of burnout and compassion fatigue by giving emotionally intensive care. While treatments for compassion fatigue and burnout are available, another way forward is needed to ensure healthcare professionals do not become ill; one that will enable both patients and healthcare professionals to receive the care needed. In this paper it is argued that compassion, which is defined in this paper, involves different neural circuitry to empathy and can protect healthcare professionals from the effects of stress that can, if not addressed, lead to burnout. Traditional Buddhist meditation techniques such as loving-kindness meditation have been shown to increase compassion in non-meditative states. Short daily sessions of such mediation practices have been shown to improve compassion in a way that protects healthcare professionals from burnout.

Measurement of Training Intensity and Work During Submaximal Isokinetic Progressive Resistance Training Protocols

Physical exercise programmes are routinely prescribed in clinical practice to treat impairments, improve activity and participation in daily life because of their known physiological, health and psychological benefits (RCP, 2009). Progressive resistance exercise is a type of exercise prescribed specifically to improve skeletal muscle strength (Latham et al., 2004). The effectiveness of progressive resistance exercise varies considerably between studies and populations. This thesis focuses on how training parameters influence the delivery of progressive resistance exercise. In order to appropriately evaluate the influence of training parameters, this thesis argues the need to record training performance and the total work completed by participants as prescribed by training protocols. In the first study, participants were taken through a series of protocols differentiated by the intensity and volume of training. Training intensity was defined as a proportion of the mean peak torque achieved during maximal voluntary contractions and was set at 80% and 40% respectively of the MVC mean peak torque. Training volume was defined as the total external work achieved over the training period. Measures of training performance were developed to accurately report the intensity, repetitions and work completed during the training period. A second study evaluated training performance of the training protocols over repeated sessions. These protocols were then applied to 3 stroke survivors. Study 1 found sedentary participants could achieve a differentiated training intensity. Participants completing the high and low intensity protocols trained at 80% and 40% respectively of the MVC mean peak torque. The total work achieved in the high intensity low repetition protocol was lower than the total work achieved in the low intensity high repetition protocol. With repeated practice, study 2 found participants were able to improve in their ability to perform manoeuvres as shown by a reduction in the variation of the mean training intensity achieving total work as specified by the protocol to a lower margin of error. When these protocols were applied to 3 stroke survivors, they were able to achieve the specified training intensity but they were not able to achieve the total work as expected for the protocol. This is likely to be due to an inability in achieving a consistent force throughout the contraction. These results demonstrate evaluation of training characteristics and support the need to record and report training performance characteristics during progressive resistance exercise, including the total work achieved, in order to elucidate the influence of training parameters on progressive resistance exercise. The lack of accurate training performance may partly explain the inconsistencies between studies on optimal training parameters for progressive resistance exercise.